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目的:探讨比较氨曲南联合万古霉素治疗复杂性细菌性皮肤和皮肤软组织感染(c SSSIs)的疗效和安全性。方法:检索维普、万方、CNKI、Cochrane、EMbase、PubMed、Medline等文献数据库。依据Cochrane Handbook5.1.0评价方法查找氨曲南联合万古霉素治疗复杂性细菌性皮肤和皮肤软组织感染的随机对照试验(RCT),进行数据提取和质量评价后,采用RevMan 5.2软件进行Meta分析。结果:共纳入4个RCT的文献,2494名患者。Meta分析结果显示:在临床治愈率(WMD=1.20,95%CI:0.89~1.61,P=0.24)、检出微生物人群中的临床治愈率(WMD=1.29,95%CI:0.89~1.87,P=0.18)、检出大肠杆菌人群中的临床治愈率(WMD=0.67,95%CI:0.14~3.10,P=0.61)方面没有显著性差异;在不良反应腹泻(WMD=0.65,95%CI:0.46~0.93,P=0.02)、恶心(WMD=0.37,95%CI:0.14~0.93,P=0.03)发生率方面氨曲南联合万古霉素显著低于对照组;头痛发生率没有显著性差异(WMD=0.81,95%CI:0.58~1.12,P=0.20)。结论:氨曲南联合万古霉素是治疗c SSSIs的一种经典治疗方案,从目前的临床疗效评价结果来看,仍然具有重要的临床应用价值,期待更多的大样本研究进一步证实。
Objective: To compare the efficacy and safety of aztreonam and vancomycin in the treatment of complicated bacterial and dermal soft tissue infections (c SSSIs). Methods: The literature databases such as VIP, Wanfang, CNKI, Cochrane, EMbase, PubMed and Medline were searched. A randomized controlled trial (RCT) of aztreonam combined with vancomycin in the treatment of complicated bacterial and dermal soft tissue infections was performed according to the Cochrane Handbook 5.1.0 evaluation method. After data extraction and quality evaluation, Meta-analysis was performed using RevMan 5.2 software. Results: There were 4 RCTs and 2494 patients. The results of Meta analysis showed that the clinical cure rate (WMD = 1.29, 95% CI: 0.89-1.87, P <0.05) was significantly higher in the clinical population (WMD = 1.20,95% CI: 0.89-1.61, P = = 0.18). There was no significant difference in the clinical cure rate among the E.coli population (WMD = 0.67,95% CI: 0.14-3.10, P = 0.61). In the adverse reaction diarrhea (WMD = 0.65,95% CI: 0.46-0.93, P = 0.02), and nausea (WMD = 0.37, 95% CI: 0.14-0.93, P = 0.03) were significantly lower in aztreonam combined with vancomycin than in control group; there was no significant difference in the incidence of headache (WMD = 0.81, 95% CI: 0.58-1.12, P = 0.20). Conclusion: Aztreonam combined with vancomycin is a classic treatment for c SSSIs. From the current clinical evaluation results, it still has important clinical value and is expected to be confirmed by more large sample studies.